MRI localization evaluation to distinguish gastric-type adenocarcinoma and lobular endocervical glandular hyperplasia from other cystic lesions

Objective To quantitatively differentiate MRI localization of gastric-type adenocarcinoma (GAS) and lobular endocervical glandular hyperplasia (LEGH) from other benign cystic lesions (OBC). Methods We retrospectively reviewed T1-weighted (T1WI) and T2-weighted images (T2WI) and measured the lesion volume, the ratio of cervical canal position at the maximum cross-section (deviation ratio), the ratio of the lesion’s centre within the craniocaudal length (longitudinal location ratio), distance from the internal and external os, maximum cyst diameter, and signal intensities of the cyst content on T1WI and T2WI (T1 and T2 ratios). These parameters were compared between GAS or LEGH and OBC, where OBC was clinically suspected of LEGH. Results Seventeen patients with GAS, 18 with LEGH (52 ± 11 years), and 42 with OBC (45 ± 10 years) were included. GAS/LEGH were larger in volume (29.25/15.24 cm3, p < 0.001), and had a greater deviation ratio (0.82/0.84, p < 0.001), shorter distance to the internal and external os (3.4/3.6 mm, p = 0.040, and 3.3/3.3 mm, p = 0.003, respectively), and a lower T1 ratio (1.08/0.91, p < 0.001). The area under the curve (AUC) of these parameters using their respective optimal cut-off values was 0.818, 0.756, 0.629, 0.711, and 0.731, respectively. When three or more positive criteria were considered, the AUC increased to 0.896. Conclusion Compared to OBC, GAS/LEGH displayed a larger volume, cervical canal deviation, proximity to the internal and external os, and a lower T1 ratio of cyst content. Advances in knowledge Considering both the lesion and its relationship to the cervical canal is imperative for differentiating between the conditions.